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Chemotherapy doesn’t just attack cancer cells; it often takes the nervous system along for the ride. In the first month after treatment, about 68% of patients develop chemotherapy-induced peripheral neuropathy (CIPN), and even six months later, 30% are still dealing with lingering nerve pain, tingling, or numbness. But how are we treating the aftermath of the initial treatment?
In a survey of nearly 2,000 cancer survivors, more than 70% reported symptoms in both hands and feet, and many said it interfered with everyday tasks like walking, household chores, hobbies, and sleep. One participant described losing confidence in walking and facing sleep disturbances, challenges that stayed long after chemotherapy had ended.
Yet, despite how common and life-altering CIPN can be, there is currently no approved treatment to prevent it. Doctors often recommend off‑label use of duloxetine to ease symptoms, but beyond that, options are limited.
That’s beginning to change. A few novel therapies are advancing in development, most prominently Asahi’s ART‑123, which entered phase 3 trials in Japan a couple of weeks ago to evaluate whether it can prevent CIPN in colorectal cancer patients receiving oxaliplatin.
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What is CIPN?
Chemotherapy-induced peripheral neuropathy, or CIPN, is one of the most common side effects of cancer treatment. It results from nerve damage caused by certain chemotherapy agents, often leading to tingling, numbness, burning sensations, or pain in the hands and feet. In more severe cases, patients may also experience muscle weakness, coordination issues, or difficulty walking, and these symptoms can persist long after treatment ends.
Several types of chemotherapy drugs are known to trigger this condition. Platinum-based agents like cisplatin and oxaliplatin are among the most well-documented culprits, with some studies reporting CIPN in up to 90% of patients receiving oxaliplatin. Taxanes, such as paclitaxel and docetaxel, frequently used in breast and ovarian cancer, are another major cause. Vinca alkaloids, commonly used in blood cancers, can also damage peripheral nerves, though often in slightly different ways.
Beyond the symptoms themselves, what makes CIPN particularly challenging is its impact on the broader course of cancer treatment. The pain or loss of function can become so intense that patients are forced to reduce their chemotherapy dose or stop treatment altogether. In one study involving breast cancer patients receiving taxane-based regimens, nearly 40% needed dose modifications. These disruptions can compromise the effectiveness of the treatment itself, creating a difficult trade-off between quality of life and cancer control.
Why is CIPN so difficult to treat?
Treating CIPN feels like aiming at a moving target. Researchers aren’t entirely sure what causes the damage; likely a mix of nerve inflammation, oxidative stress, and mitochondrial failure. Yet, no single mechanism fully explains the condition. Studies have shown that chemotherapy drugs can inflict direct harm on nerves and their support cells, disrupt nerve-glia signaling, and activate inflammatory pathways in the spinal cord and dorsal root ganglia. But this tangled web of biology makes it hard to identify a clear therapeutic target.
On top of that, measuring CIPN in patients is tricky. Clinicians rely heavily on subjective reporting: how a patient describes tingling or weakness, which varies greatly from person to person. While there are scales like the NCI Common Toxicity Criteria and objective tests like nerve conduction studies, these tools often lack sensitivity and consistency. That inconsistency complicates evaluating whether a drug actually helped.
And then there’s the business side. CIPN is perceived primarily as a quality-of-life issue, not a life-saving one. Drug developers are wary: could a CIPN treatment interfere with chemotherapy’s cancer-fighting power? Or worse, might it unintentionally aid tumor growth? Such commercial and regulatory uncertainties, especially in light of the new FDA draft guidance for CIPN products, mean many companies simply avoid the space.
What’s in the pipeline for CIPN treatment?
After years of neglect, the CIPN field is finally seeing serious activity. At the forefront is ART‑123, but a growing list of diverse candidates suggests the tide is turning.
Asahi Kasei’s ART‑123
Asahi Kasei’s recombinant thrombomodulin, known as ART‑123 or Recomodulin, is the most advanced CIPN therapy in development. First used in Japan to treat disseminated intravascular coagulation, ART‑123 is now being tested in a phase 3 study for CIPN prevention in colorectal cancer patients receiving oxaliplatin.
The mechanism is straightforward: thrombomodulin activation influences protein C and inhibits TAFI, which together may curb neuroinflammation and protect nerve function. Earlier phase 1 and 2 studies supported this hypothesis, showing a favorable safety profile and slower onset of sensory symptoms.
If this trial confirms efficacy, ART‑123 could become the first preventive treatment for CIPN.
AlgoTherapeutix’s ATX01
AlgoTherapeutix’s ATX01 offers a different approach: a non-opioid, topical gel that targets nociceptive sodium channels in skin nerves. In February 2025, the company shared results from its phase 2 trial. While the overall results were muddled by placebo effects, ATX01 at 15% concentration stood out in select sites, delivering a clinically meaningful 1.6-point pain reduction on the NPRS.
Importantly, ATX01 was well-tolerated, and this post-hoc success offers a clear roadmap: refine patient selection, control placebo influence, and confirm efficacy.
Osmol Therapeutics’ OSM‑0205
A newcomer with clinical momentum, OSM‑0205 from Osmol Therapeutics addresses a root problem: taxane-induced calcium overload in neurons. Modeled on Yale lab findings implicating neuronal calcium sensor-1 (NCS1), OSM‑0205 is designed as an intravenous infusion given before chemo to block the calcium spike and shield nerves.
An IND was filed in August 2023, and a phase 1 trial has been initiated in healthy volunteers. The company plans to initiate phase 2 trials in the second half of 2026.
In addition to headliners, a Pharma‑Technology overview from 2024 counted 61 CIPN-focused candidates in development, although a lot remain in preclinical stages.
A field on the cusp?
CIPN is gradually stepping into the spotlight. As long-term cancer survival improves, so does the recognition that side effects like peripheral neuropathy.
At ASCO 2025, several poster sessions focused on CIPN’s trajectory, impact on survivorship, and early interventions. There is growing interest into what it represents for the patients but also into the mechanisms behind CIPN.
Thanks to recent reviews and modeling efforts, scientific understanding is more structured. Frameworks like the “3P model” consider predisposing, precipitating, and perpetuating factors.
New market data sees the CIPN treatment sector growing from roughly $1.65 billion in 2024, and expected to approach $2.95 billion by 2034, with a CAGR of 5 to 6 %. That growth mirrors broader trends in oncology supportive care, a $35 billion market in 2024 projected to nearly double by 2034.
If ART‑123, ATX01, or OSM‑0205 can demonstrate solid clinical benefits, it could establish CIPN as a viable commercial indication, making the prevention of chemo-side effects strategic in the eyes of investors and biotechs.
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